Curriculum

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Educational Objectives

The Sisters Hospital Obstetrics and Gynecology Residency is a progressive, structured educational experience, including formal and informal activities.
This program strives to impart all residents with the medical knowledge, technical skill, clinical judgment and professional responsibility that will enable them to provide excellent care for women and to fulfill the requirements of the American Board of Obstetrics and Gynecology.
With that goal in mind, specific educational objectives include:

  • To create an environment that fosters excellence in the six core competencies of medical knowledge, patient care, systems-based practice, practice-based learning, interpersonal and communication skills, and professionalism.
  • To develop the habits of lifelong learning.
  • To develop a strong sense of intellectual and ethical integrity.
  • To promote the need to serve patients with sensitivity regardless of their socioeconomic status, race, creed, country of origin or religion.
  • To acquire an awareness of the socioeconomic, cultural and medical-legal factors that impact the practice of obstetrics and gynecology.
  • To be able to recognize one's own physical, emotional and mental limitations and the impact of the high-intensity clinical scenarios inherent to our specialty.

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The Elements of Residency

The four years of residency are a continual progression of increasing knowledge, skills, and professional capabilities and the development of a strong sense of responsibility for the entire healthcare team. 

First Year

The first-year resident must start by mastering the fundamental concepts of anatomy, physiology, and pharmacology as they relate to the normal obstetric and gynecological patient. The interns are closely supported by the Chief Resident(s) and supervised in the outpatient continuity clinic by a core faculty member. During the first year, there are also rotations in neonatal intensive care, primary care, family planning and adult intensive care. The outside rotations provide time to study and take the USMLE/COMLEX Step III. First-year residents obtain NCC certification in electronic fetal monitoring and complete the Neonatal Resuscitation Program.

Second Year

During the second year, emphasis is placed on high-risk obstetrics with rotations in ultrasound and maternal-fetal medicine. The second-year residents learn how to “run the board” in Labor and Delivery with the support of their Chief Resident and in-house Supervising Attending Physician. The second-year resident spends one month dedicated to developing obstetric ultrasound skills. He or she spends an additional two months on the Maternal Fetal Medicine service where those skills can be applied to help manage the antepartum service. Several graduates have found they have had enough ultrasound experience to sit for and pass the Registered Diagnostic Medical Sonographer exam. The middle of the second year contains an entire module devoted to Research and Quality and Patient Safety (QPS). This provides each resident with protected time to collect data and prepare their abstract. It also allows the resident to gain insight into the workings of the hospital system as they participate in QPS activities. At the end of the year, the focus turns to preparing for advanced gynecologic surgery with an entire month devoted to surgical education and simulation training at the Applied Technology Laboratory for Advanced Surgery (ATLAS) at Roswell Park Cancer Institute (RPCI). This time includes on-line introduction to the da Vinci surgical system, didactic and hands-on preparation for the Fundamentals of Laparoscopic Surgery certification exam, robotic surgical simulation with both dry and porcine labs, opportunities to observe expert robotic surgeries and time on the da Vinci surgical simulator.  

Third Year

The third-year resident shifts his or her attention from obstetrics to the areas of gynecologic surgery, oncology, reproductive endocrinology and infertility. The third year includes two (2) modules on the Gyn Oncology service at the Roswell Park. The resident is an active member of the team that includes fellows and attending gynecologic oncologists who are active in research and clinical trials. Learning the national standards for cancer care and increasing operative experience are important aspects of the resident’s time at RPCI. Each resident spends two (2) modules with the Buffalo IVF and Infertility group. This experience includes two days a week in the operating room and two days in the office participating in outpatient consultations and learning about assisted reproductive technologies. The third year is further enhanced by exposure to new surgeons at Mercy Hospital of Buffalo. This experience augments the resident’s surgical tool kit with new techniques and approaches while helping to ensure that all residents reach their ACGME case log minimums.

The third-year resident assumes a greater role in caring for the sick gynecologic patients and the teaching of the medical students from the State University of New York at Buffalo, Lake Erie College of Osteopathic Medicine and New York College of Osteopathic Medicine. 

Fourth Year

During the fourth year of training, there is a strong emphasis on integrating all of the previous years' experience, acquiring additional technical skill and assuming a major role in the formulation and execution of management plans for all patients. This is especially true for the Sisters Ob/Gyn Center (Staff) patients.

The Ob Chief Resident runs morning report and evening sign-out. He or she rounds daily with the in-house Supervising Attending Physician on all staff patients. The Gyn Chief Resident assigns coverage for all surgical cases and takes the lead on the oncology service which includes regular contact with the gynecologic oncologists who practice at Sisters of Charity Hospital.  The MIGS Chief operates and has clinic time with Dr. Ali Ghomi, the Director of Robotic Surgery, who is board certified in Female Pelvic Medicine and Reconstructive Surgery.  As part of their Systems-based Practice education, the Chief residents are required to actively participate in the QPS process by presenting cases at the monthly meetings and working with the Ob Safety Committee to foster communication and best practice on Labor & Delivery.

The Chief Residents serve as role models of teaching and professional behavior for the junior residents and medical students. The Chief Residents coordinate care and advocate for the patients as if they were their own. An important part of the final year of training is taking responsibility for the performance of the entire team. 

Annual Schedule

The academic year is divided into thirteen (13) four-week modules per year. The following represents the rotations for our residents:

PGY Level OB GYN Nights MFM SONO Research QPS Atlas RPCI REI Mercy GYN MIGS
I  3  3  3 * * * * * * * *
II  3  2  3 2 1 1 1
III  1.25  3.25  1.25 2 2 3.25
IV  3.25  3.25 3.25 3.25

Key:

*One module each of NICU, Primary Care, Family Planning, and ICU.

QPS = Quality and Patient Safety

ATLAS = Applied Technology Laboratory for Advanced Surgery Training Program at RPCI

MFM = Maternal Fetal Medicine

RPCI = Roswell Park Cancer Institute

REI = Reproductive Endocrinology and Infertility

MIGS = Minimally Invasive Gynecologic Surgery

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The Learning Environment

Special BirthPlace

The Special Birth Place, our Labor and Delivery unit, is equipped with two triage rooms, ten labor/delivery rooms, two operating rooms, and a three-bed post-operative recovery unit. We have 24-hour in-house coverage by both anesthesiology and neonatology. Our Level III NICU attracts transfers from across Western New York. Sisters Hospital assists with over 3,000 deliveries every year and provides the residents the full range of obstetrical practice from patients seeking a natural birth experience to high-risk patients with multiple comorbidities requiring a multidisciplinary team. 

Surgery

Sisters Hospital has over 800 major and 1,400 minor gynecologic cases each year. Our faculty enjoy teaching and working with residents. There is ample experience in abdominal, vaginal, and laparoscopic surgery. We have the da Vinci Xi Surgical System at Sisters and the Si platform at our St. Joseph’s Campus. Mercy Hospital, where the third- and fourth-year residents operate, has two robots. Roswell Park Cancer Institute, where the third-year residents spend two months, has multiple da Vinci surgical systems used in the treatment of gynecological malignancies. The residents progress through a pathway of training with the goal of being credentialed to perform robotic-assisted procedures upon graduation.

Rounds

Morning Report is every weekday at 07:00 and Sign-Out is every evening at 17:00. All in-house residents gather with the in-house Supervising Attending Physician to hand off their patients. This gives the residents and the attending an opportunity to discuss diagnosis and management plans and optimize patient care. The morning session promotes educational discussion while the evening session focuses on an organized and concise hand-off. Faculty specializing in Maternal-Fetal Medicine, Gynecologic Oncology and Pelvic Medicine attend these rounds on a weekly basis to discuss cases of interest. 

Sisters OB/GYN Center

The Sisters Ob/Gyn Center is the residents’ outpatient continuity clinic. It is located within Sisters Hospital, and each resident spends one half-day session there each week. Residents on Nights are excused. Third-year residents rotating at RPCI and Chief Residents on Gyn are also excused when they have surgical cases of interest like vaginal hysterectomy. Residents follow high-risk obstetric patients as well as see routine and complicated gynecologic patients. Residents perform colposcopy, endometrial biopsy, saline-infusion sonography and other minor surgical procedures. Sisters Ob/Gyn Center serves a largely underprivileged and immigrant population.

Education

Wednesday morning is protected time for our residents. After morning report, the time between 08:00 and 13:00 is reserved for educational activities. The Academic Calendar includes didactic lectures from core and guest faculty, CREOG exam preparation. M&M Conferences, review of ACOG Practice Bulletins and multidisciplinary meetings to discuss our high-risk patients. Chief Residents handle emergencies so that the rest of the team can focus on education. The resident educational experience is augmented by completion of 12-16 Case Network online learning modules each year. These interactive case studies cover the six (6) core competencies and map each resident’s performance to the Ob/Gyn Milestones. Journal Club meets eight (8) months out of the year.  Each resident presents once throughout the course of the academic year. These meeting are held over dinner immediately following evening sign-out. Residents also participate in emergency drills, multidisciplinary meetings and case conferences. 

Call and Duty Hours

The program utilizes a night float system. Residents on Nights work five (5) nights in a row - usually Sunday through Thursday from 17:00 until 08:00. The day residents take call on the weekends and holidays. Day residents who are on call typically work 24 hours on Friday or 24 hours on Saturday or 12 hours on Sunday. We try to maximize the number of weekends completely off. Including weekends off during Nights and vacation, each junior resident has 20-22 weekends completely off each year. Chief residents have thirty such weekends.

The residency program adheres to both the ACGME and New York State 405 work hours regulations. Residents work no more than 80 hours per week and have one complete day off every 7 days. The average hours worked for all residents during a typical academic year is 63.5 hours per week. All residents receive four weeks of vacation and accrue sick time per the policies of the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo. 

Research

Each resident is expected to develop and conduct his or her own clinical research project throughout their time at Sisters Hospital. Residents are encouraged to submit a complete abstract to a national or regional organization to present at one of its meetings. These trips are supported financially by the hospital. Some projects will be worthy of publication and should be submitted by the beginning of the fourth year. Guidance is provided by a faculty mentor. This research is to be completed and is presented in the third and fourth year of residency.

A sampling of recent publications from our residents include:

  • Barr JJ & Caruso-McEvoy. Validation of the Postpartum Social Support Questionnaire in low-income, African American women. J Family Social Work 2017. E-published ahead of print. http://dx.doi.org/10.1080/10522158.2017.1350894
  • Eng KH, Morrell K, Starbuck K, Spring-Robinson C, Khan A, Cleason D, Akman L, Zsiros E, Odunsi K, & Szender JB. Prognostic value of miliary versus non-miliary sub-staging in advanced ovarian cancer. Gynecol Oncol 2017; 146(1):52-57.
  • Sanderson DJ & Ghomi A. Robot-assisted laparoscopic myomectomy: a comparison of techniques. J Minim Invasive Gynecol 2015;22(6S):S18.
  • Sanderson DJ & Ghomi A. Bilateral obturator neuropathy after transobturator vaginal sling: a case report. Female Pelvic Med Reconstr Surg 2015;21(2):e21-2.
  • Ghomi A, Kramer C, Askari R, Chavan NR, & Einarsson JL. Trendelenburg position in gynecologic robotic-assisted surgery. J Minim Invasive Gynecol. 2012;19(4):485-9.

Wellness

Our program is committed to building resident resiliency throughout the four-year journey of training. We have an annual retreat that allows the entire house staff to come together for team building and bonding. We have instituted quarterly wellness days that include lectures on nutrition, self-care, mindfulness, a provided lunch and time for the residents to huddle as a team.

Standards

Conduct of all house officers is governed by the Standards of Behavior for Catholic Health, the policies and procedures of the University at Buffalo Office of Graduate Medical Education, the code of ethics provided by the American Medical Association and the current National Conference of Catholic Bishops Ethical and Religious Directives for Catholic Health Care Facilities.

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